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General NPI Number Information
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NPI Number | 1518900257
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Entity Type | Individual
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Provider Name | KONRAD TOMAZ STEPNIAKOWSKI MD
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6490 MOUNT MORIAH ROAD EXT SUITE 200
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City | MEMPHIS
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State | TN
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Zip | 38115-3729
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Country | US
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Telephone | 901-565-0244
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Fax | 901-565-0616
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Provider Business Mailing Address
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Address Line | 6490 MOUNT MORIAH ROAD EXT SUITE 200
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City | MEMPHIS
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State | TN
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Zip | 38115-3729
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Country | US
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Telephone | 901-565-0244
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Fax | 901-565-0616
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD036208
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 50061
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | E-5830
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License Number State | AR
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